61例老年2型糖尿病合并高尿酸血症临床分析

老年（年龄≥60岁）2型糖尿病患者273例，分为伴高尿酸血症者61例为A组和不伴尿酸血症者212例为B组。结果A组较男性多、更胖，收缩压和舒张压增高，甘油三酯（TG）增高，高密度脂蛋白胆固醇（HDL-C）降低，胰岛素抵抗指数增高；血尿酸与甘油三酯、总胆固醇、BMI、血压等呈正相关（P〈0．01），与HbA1c、HDL-C呈负相关（P〈0．01），与病程、LDL-C无相关（P〉0．05）；代谢综合征等患病率明显升高。结论提示老年2型糖尿病高尿酸血症是代谢综合征等发病的危险因素之一。     

61例老年2型糖尿病合并高尿酸血症临床分析

老年（年龄≥60岁）2型糖尿病患者273例，分为伴高尿酸血症者61例为A组和不伴尿酸血症者212例为B组。结果A组较男性多、更胖，收缩压和舒张压增高，甘油三酯（TG）增高，高密度脂蛋白胆固醇（HDL-C）降低，胰岛素抵抗指数增高；血尿酸与甘油三酯、总胆固醇、BMI、血压等呈正相关（P〈0．01），与HbA1c、HDL-C呈负相关（P〈0．01），与病程、LDL-C无相关（P〉0．05）；代谢综合征等患病率明显升高。结论提示老年2型糖尿病高尿酸血症是代谢综合征等发病的危险因素之一。     

高脂血症与高血压的关系（社区研究）

目的 探讨高脂血症对高血压（EH）的影响，研究两者间的关系。方法 在502例部分社区自然人群中随机抽取100例血脂正常者做为对照组，分别观察同时检出的110例高胆固醇血症、170例高甘油三脂血（hTG)症、173例高低密度脂蛋白－胆固醇（hLDL-c)血症和171例高高密度脂蛋白－胆固醇血症（hHDL-c)对EH的影响。结果 hTC组、hLDL-c组和hHDL-c症组的EH患病率分别为31．82％、24．70％、26．59％和10．53％，与对照组14．00％的高血压患病率比较，hTC组和hLDL-c组均有显著性差异（P＜0．001）；hTG血症有显著性差异P＜0．005，而hHDL-c血症组则无显著性差异（P＞0．05）。hTC血症、hTG血症，hLDL-c血症患EH的相对危险度分别是对照组的2．3、1．8、1．9和0．8。结论 高脂血症与EH有密切关系，而hHDL-c血症则相反。提示：高脂血症是EH的间接危险因素。     

高尿酸血症及其影响因素分析

目的了解人群血尿酸水平和高尿酸血症的患病率及其影响因素。方法对2007年3月～2009年10月在本院进行健康体检的2556名人群的血尿酸水平和高尿酸患病率的结果进行统计分析。结果高尿酸血症的患病率为16．6％;男性高尿酸血症的患病率为19．1％,女性为13．3％,男性高于女性（P〈0．01）,且血尿酸水平和高尿酸血症患病率有逐年增高趋势（P〈0．01）。结论高尿酸血症存在不同年份、性别、年龄间差别,与多种因素有关。     

国人男女冠心病发病危险因素分析

目的：了解男女冠心病（CHD）发病的危险因素。方法：研究对象为2005年1月～2010年6月间行冠状动脉造影检查者,其中男853例,女164例。对CHD患者均采集详细病史和相应血生化指标。其血浆纤维蛋白原（Fg）测定采用凝血酶方法,血清总胆固醇（Tc）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL—c）及高密度脂蛋白胆固醇（HDL—C）测定采用标准酶法。结果：男女间糖尿病患病率、LDL-C和Fg水平均无显著异（P〉0．05）;女性CHD患者发病年龄[（66．8±10．4）岁比（58．9±11．7）岁],高血压患病率（68．9％比56．7％）,TC[（5．1±1．4）mmol／L比（4．5±0．9）mmol／L]、TG[（2．1±1．4）mmol／L比（1．8±1．2）mmol／L]浓度明显高于男性（P〈0．05～〈0．001）,吸烟率（8．5％比55．0％）,尿酸[（336．6±102．6）mmol／L比（364．7±112．4）mmol／L]水平明显低于男性（P％0．01）。结论：男女冠心病发病危险因素状况不同,女性冠心病合并高血压、脂质代谢紊乱较多,而男性冠心病发病年龄明显提前,以吸烟、血尿酸水平增高为主要表现。     

2型糖尿病患者颈围与血脂关系及其对血脂异常的预测作用——北京社区糖尿病研究（BCDS-10）

目的了解2型糖尿病患者颈围与血脂谱问的关系。方法选择2008年8月至2009年7月北京三甲医院与15个城区社区联合开展糖尿病纵向管理项目基线数据库中2410例2型糖尿病患者。全体参与医师经过专门培训,按统一要求调查并填写调查表,同时对患者进行体格检查及相关的实验室检查,血脂异常的诊断根据2007年中国成人血脂异常防治指南。结果（1）2410例中男986例,女1424例。平均颈围为（36±4）cm。总胆固醇为（5．2±1．1）mmol／L;甘油三酯为（1．8±1．2）mmol／L;高密度脂蛋白胆固醇（HDL-C）为（1．3±0．4）mmol／L;低密度脂蛋白胆固醇（LDL-C）为（3．0±0．9）mmol／L;（2）男性、女性的颈围均与甘油三酯呈正相关（男性r=0．093,女性r=0．077,均P〈0．01）,与HDL-C呈负相关（男性r=一0．144,女性r=一0．062,均P〈0．05）;（3）预测高甘油三酯血症最佳的颈围切点：男性为37em,女性为35em;预测HDL-C降低的颈围切点男性为40em,女性为35em;（4）预测高胆固醇血症受试者操作特征（ROC）曲线下面积男性组为0．511,女性组为0．480（P〉0．05）;预测LDL-C升高ROC曲线下面积男性为0．527;女性为0．519（P〉0．05）。结论2型糖尿病患者的颈围与血脂密切相关,尤其是甘油三酯和HDL-C;颈围可能做为筛查／评价2型糖尿病患者血脂异常的指标之一。     

高血压伴鼾症低氧血症与血浆肾素血管紧张素及醛固酮的关系

目的：探讨EH合并鼾症患者低氧血症与肾素-血管紧张素-醛固酮系统（RAS）的关系。方法：EH患者126例，其中合并打鼾和／或体重指数≥25kg／m^2的患者，夜间行7h以上多功能生命体征监测。血氧饱和度（SaO2）较醒时下降≥4％者为合并低氧血症组，最低SaO2≥85％为轻度组，〈85％为中度组；下降不足4％者为单纯EH组。测定并比较三组血浆RAS水平。结果：（1）EH合并中度低氧血症组夜间最低心率明显高于EH组（P〈0．05）；（2）EH伴轻、中度低氧血症患者血浆立、卧位醛固酮（ALD）水平均高于单纯EH组（P〈0．05）；（3）立、卧位血浆ALD水平与夜间最低SaO2明显相关（r=0．24和0．25，P〈0．05）；与SaO2下降程度也明显相关（r=0．238和0．249，P〈0．05）。结论：鼾症低氧血症病人血浆醛固酮水平上升，且与SaO2下降程度呈正相关。     

老年体检人群高尿酸血症与并发疾病分析

目的了解老年人（≥60岁）高尿酸血症的患病及合并相关疾病情况,探索老年人进行高尿酸检查的重要性。方法以2008年在本中心健康体检且资料完整的2889例老年人为研究对象,比较分析高尿酸血症组与正常尿酸组的临床指标。结果血尿酸增高患者的比例为14．78％（427／2462）,男、女患病率间差异有统计学意义（Х^2=8．598,P=0．000）。高尿酸血症组与正常尿酸纽血糖水平间差异无统计学意义（P〉0．05）;血清总胆固醇、三酰甘油、低密度脂蛋白、高密度脂蛋白间差异均有统计学意义（P〈0．05）。高尿酸血症组与正常尿酸组高胆固醇血症、高三酰甘油血症、高血糖患病率间差异均有统计学意义（P〈0．05）。结论高尿酸血症与高血脂、高血糖有明显相关性,加强对高尿酸血症的筛查工作,对减少心脑血管疾病合并症至关重要。     

老年单纯收缩期高血压患者血浆同型半胱氨酸与心血管危险因素相关性研究

目的观察血浆同型半胱氨酸（homocysteine，tHcy）与老年单纯收缩期高血压（ISH）患者心血管危险因素和靶器官损害的相关性。方法测定90例老年ISH患者血压和血脂，并检测其血Hcy浓度、血清白介素-6（IL-6）、白介素-8（IL-8）、尿微量白蛋白（MAU），测定左室质量指数（LVMI），利用彩色多普勒超声测定肱动脉内皮舒张功能（FMD）和颈动脉内膜厚度（CIMT）。结果（1）Hcy与心血管危险因素相关性：利用单变量分析显示：Hcy与血清甘油三酯（r=0．318，P=0．003）呈正性相关，与胆固醇（r=0．238，P=0．029）、低密度脂蛋白（r=0．221，P=0．043）、脉压差（r=0．253，P=0．019）无相关性；而采用多因素逐步回归分析发现：Hcy与血清甘油三酯（r=0．302，P=0．004）呈正相关，但与脉压差、（r=0．217，P=0．038）胆固醇、低密度脂蛋白、高密度脂蛋白、收缩压及舒张压无相关。（2）Hcy与血清炎性因子相关性：Hcy与IL-6呈正性相关（r=0．426，P=0．000）.（3）Hcy与内皮功能相关性：校正年龄、血脂及血清炎性因子，利用偏相关分析表明Hcy与FMD的变化呈负相关（r=-0．332，P=0．003）。（4）Hcy与靶器官损害关系：未发现Hcy与CIMT、LVMI及MAU之间存在相关性。结论高同型半胱氨酸血症与心血管危险因素有一定相关性，是老年单纯收缩期高血压的一个独立危险因素。     

北京地区急性冠心病事件死亡率1984～1993年变化趋势及影响因素的探讨

在北京地区70万自然人群中，对急性冠心病事件的死亡率及有关的危险因素进行了十年（1984～1993）监测。其结果显示：35～74岁男性年平均冠心病死亡率，90．1／10万，女性死亡率为53．9／10万；1993年死亡率比1984年男性增高17％，女性增高56％。1993年比1984年男性发病率增高36％，女性增高66％。同时期三次（1984~1985，1988～1989，1993年）在监测人群中进行心血管危险因素抽样调查，结果显示：第三次与第一次相比男性吸烟率增长25％；男女两性平均收缩压均增长0．133kPa（1mmHg）（0．8％）；平均总胆固醇水平男性上升11．2mg％（7．0％），女性上升7mp％（4．4％）。本研究提示：北京地区急性冠心病死亡率呈持续上升趋势，这种趋势推测主要受发病率上升的影响，人群中冠心病危险因素水平的增加是影响发病率上升的重要原因。     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

Assessment of quality of life of parents of children with juvenile chronic arthritis

The aim of the study was to assess the quality of life (QOL) and the psychological status of parents of children with juvenile chronic arthritis (JCA). The QOL, anxiety and depression of the parents of 28 children with JCA were evaluated and compared to those of the parents of 28 healthy children. Mothers of JCA children and mothers of healthy children reported similar QOL. The reported anxiety and depression levels were similar for mothers and fathers in both groups. The parents of children with pauciarticular-type JCA reported lower QOL and higher levels of anxiety and depression than the parents of children with other types, namely polyarticular and systemic JCA. These findings may be explained by the fact that the pauciarticular patients had shorter disease duration and were less frequently seen in the outpatient clinic. The QOL of mothers of children with JCA was found to be slightly impaired in the group of children with pauciarticular JCA. Future larger studies are needed to confirm these results, as the number of subjects in the three groups was rather low. Received: 26 September 2001 / Accepted: 8 February 2002     

Numerical Simulation of the Effect of Rate of Change of Glucose on Measurement Error of Continuous Glucose Monitors

Background

A 5-day in-patient study designed to assess the accuracy of the FreeStyle Navigator® Continuous Glucose Monitoring System revealed that the level of accuracy of the continuous sensor measurements was dependent on the rate of glucose change. When the absolute rate of change was less than 1 mg•dl⁻¹•min⁻¹ (75% of the time), the median absolute relative difference (ARD) was 8.5%, with 85% of all points falling within the A zone of the Clarke error grid. When the absolute rate of change was greater than 2 mg•dl⁻¹•min⁻¹ (8% of the time), the median ARD was 17.5%, with 59% of all points falling within the Clarke A zone.

Method

Numerical simulations were performed to investigate effects of the rate of change of glucose on sensor measurement error. This approach enabled physiologically relevant distributions of glucose values to be reordered to explore the effect of different glucose rate-of-change distributions on apparent sensor accuracy.

Results

The physiological lag between blood and interstitial fluid glucose levels is sufficient to account for the observed difference in sensor accuracy between periods of stable glucose and periods of rapidly changing glucose.

Conclusions

The role of physiological lag on the apparent decrease in sensor accuracy at high glucose rates of change has implications for clinical study design, regulatory review of continuous glucose sensors, and development of performance standards for this new technology. This work demonstrates the difficulty in comparing accuracy measures between different clinical studies and highlights the need for studies to include both relevant glucose distributions and relevant glucose rate-of-change distributions.     

Study of constancy of hydrogen-consuming flora of human colon

The constancy of the hydrogen consuming flora of the human colon was studied in 15 healthy subjects via two measurements obtained 18 to 36 months apart. Hydrogen disappearance rate and the major products of H₂-consuming bacteria, methane and sulfide, were measured during incubation of fecal homogenates with excess hydrogen and sulfate. In 11/15, the hydrogen consumption rate and the predominant hydrogen-consuming pathway (methanogenesis, sulfate reduction, or neither) remained constant. However, major shifts in these pathways were observed in four subjects, with two losing and two gaining the ability to produce methane. Methanogenesis was associated with the highest hydrogen consumption rate. This study demonstrates that clinically unrecognizable, major alterations of the colonic flora occur in healthy subjects. Understanding of the factors responsible for these alterations might allow for therapeutic manipulation of the colonic flora.Supported in part by the Department of Veterans Affairs and NIDDKD RO1 DK 13309-25.